| 1. |
- Andersson, Bodil T., et al.
(författare)
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Radiographers' areas of professional competence related to good nursing care
- 2008
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Ingår i: Scandinavian Journal of Caring Sciences. - : Blackwell Munksgaard. - 0283-9318 .- 1471-6712. ; 22:3, s. 401-409
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Tidskriftsartikel (refereegranskat)abstract
- Background: Radiographers’ ability and competence is a matter of vital importance for patients. Nursing care is an integral part of the radiographer’s work. The demand for high competence in clinical activities has increased in diagnostic radiology and has had an impact on the development of the profession.Aim: The aim was to describe the radiographer’s areas of professional competence in relation to good nursing care based on critical incidents that occur in the course of radiological examinations and interventions.Method: A descriptive design with a qualitative approach, using the Critical Incident Technique was employed. Interviews were conducted with a strategic sample of registered radiographers (n = 14), based at different hospitals in Sweden.Ethical issues: The appropriate ethical principles were followed. All the participants provided informed consent, and formal approval for conducting the research was obtained according to national and local directives.Results: The data analysis resulted in two main areas; direct and indirect patient-related areas of competence, which describe the radiographers’ skills that either facilitate or hinder good nursing care. In the direct patient-related area of competence, four categories emerged, which illustrate good nursing care in the patient’s immediate surroundings. In the indirect patient-related area of competence, four categories illuminated good nursing care that is provided without direct contact with the patient.Conclusions: The study highlights the different areas of the radiographer’s unique professional competence. The findings provide insight into the radiographer’s profession, on one hand as a carer and on the other as a medical technologist as well as highlighting the importance of each role. The radiographer’s work encompasses a variety of components – from caring for the patient to handling and checking the technical equipment.
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| 2. |
- Leo, Ulf, et al.
(författare)
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Analysis and Reflections
- 2014
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Ingår i: Enforcing Child Rights Globally. - 9789198053555 ; , s. 141-156
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Bokkapitel (refereegranskat)
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| 3. |
- Alfredsson, Emma, et al.
(författare)
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Background - Framework and Content of the ITP programme
- 2016. - 1
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Ingår i: Realising Child Rights in Education : Experience and Reflections from the International Training Programme on Child Rights, Classroom and School Management - Experience and Reflections from the International Training Programme on Child Rights, Classroom and School Management. - 9789198226164 ; 1, s. 7-27
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Andersson, Bodil, et al.
(författare)
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Fatal Acute Pancreatitis Occurring Outside of the Hospital: Clinical and Social Characteristics.
- 2010
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; Jul 1, s. 2286-2291
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mortality caused by acute pancreatitis in patients admitted to the hospital has been thoroughly investigated, but knowledge regarding outpatient fatalities is far from complete. The purpose of this study was to assess the incidence and clinical characteristics of patients who have died due to acute pancreatitis occurring outside the hospital. METHODS: Deaths caused by acute pancreatitis in the southern part of Sweden during 1994-2008 were identified at the Department of Forensic Medicine, Lund. A retrospective review of all cases was performed. RESULTS: A total of 50 patients were included, representing approximately 50 of 292 (17%) of all deaths due to acute pancreatitis in the region during this period of time. Median age was 54 (47-69) years and the majority-37 (74%)-were men. The main etiology was alcohol, seen in at least 35 (70%) patients. Twelve (24%) patients were obese. The duration of abdominal pain, in evaluable cases, was 3.0 (1.6-6.2) days. Profound signs of pancreatitis were seen in all patients; 35 (70%) had a necrotising disease according to histopathological examination. Pulmonary changes were common, e.g., bronchopneumonia, pleural effusion, or edema, and all but four had fatty liver. Massive intra-abdominal bleeding was seen in one patient. At least eight patients had a mental disorder, and three were homeless. CONCLUSIONS: Fatal acute pancreatitis occurring outside the hospital accounts for a substantial part of all deaths due to the disease. The incidence seems to decline, and no variation in season was seen. Alcohol was the predominant etiology. Many of the patients lived alone and in poor social conditions.
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| 5. |
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| 6. |
- Andersson, Roland, et al.
(författare)
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Acute pancreatitis - from cellular signalling to complicated clinical course.
- 2007
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Ingår i: HPB. - : Elsevier BV. - 1477-2574 .- 1365-182X. ; 9:6, s. 414-420
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Tidskriftsartikel (refereegranskat)abstract
- Acute pancreatitis (AP) is a common disease that has a mild to moderate course in most cases. During the last decade, a change in diagnostic facilities as well as improved intensive care have influenced both morbidity and mortality in AP. Still, however, a number of controversies and unresolved questions remain regarding AP. These include prognostic factors and how these may be used to improve outcome, diagnostic possibilities, their indications and optimal timing, and the systemic inflammatory reaction (systemic inflammatory response syndrome - SIRS) and its effect on the concomitant course of the disease and potential development of organ failure. The role of the gut has been suggested to be important in severe AP, but has recently been somewhat questioned. Despite extensive research, pharmacological and medical intervention of proven clinical value is scarce. Various aspects on surgical interventions, including endoscopic sphincterotomy, cholecystectomy and necrosectomy, as regards indications and timing, will be reviewed. Last, but not least, are the management of late complications and long-term outcome for patients with especially severe AP.
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| 7. |
- Andersson, Roland, et al.
(författare)
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Immunomodulation in surgical practise
- 2006
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Ingår i: HPB. - : Elsevier BV. - 1477-2574 .- 1365-182X. ; 8:2, s. 116-123
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Tidskriftsartikel (refereegranskat)abstract
- Background. Immunomodulation may represent a potential way to improve surgical outcome. These types of interventions should be based on detailed knowledge of the underlying mechanisms involved. The aim of the present review is to summarize some experience on the acute phase response, potential ways of intervention and experiences from critical illness and HPB disease. Discussion. Mechanisms of the acute phase response are discussed including the individual parameters and local changes that take part. Mechanisms involved in failure of the gut barrier are presented and include changes in gut barrier permeability, effects on gut-associated immunocompetent cells, and systemic implications. As examples of HPB disease, mechanisms of the acute phase response and potential ways of intervention in obstructive jaundice and acute pancreatitis are discussed. Nutritional pharmacology and lessons learned from immunomodulation and immunonutrition in critical illness and major abdominal surgery, including upper GI and HPB surgery, are referred to. Overall, immunomodulation represents a potential tool to improve results but requires a thorough mapping of underlying mechanisms in order to achieve individualized treatment or prevention based on patients' specific needs.
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| 8. |
- Ansari, Daniel, et al.
(författare)
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Chronic pancreatitis: potential future interventions.
- 2010
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 45:9, s. 1022-1028
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Forskningsöversikt (refereegranskat)abstract
- Chronic pancreatitis is a common disorder of which the underlying pathogenic mechanisms still are incompletely understood. In the last decade, increasing evidence has shown that activated pancreatic stellate cells play a key role in the fibrosis development associated with chronic pancreatitis as well as pancreatic cancer. During pancreatic injury or inflammation, quiescent stellate cells undergo a phenotypic transformation, characterized by smooth muscle alpha-actin expression and increased synthesis of extracellular matrix proteins. Hitherto, specific therapies to prevent or reverse pancreatic fibrosis are unavailable. This review addresses current insights into pathological mechanisms underlying chronic pancreatitis and their applicability as concerns the development of potential future therapeutic approaches.
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| 9. |
- Leo, Ulf, et al.
(författare)
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Background
- 2014
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Ingår i: Enforcing Child Rights Globally. - 9789198053555 ; , s. 7-13
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Bokkapitel (refereegranskat)
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| 10. |
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| 11. |
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| 12. |
- Leo, Ulf, et al.
(författare)
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The Role of Change Agents
- 2014
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Ingår i: Enforcing Child Rights Globally. - 9789198053555 ; , s. 171-187
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Bokkapitel (refereegranskat)
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| 13. |
- Rasmusson, Bodil, et al.
(författare)
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Looking back and looking forward
- 2016. - 1
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Ingår i: Realising Child Rights in Education : Experience and Reflections from the International Training Programme on Child Rights, Classroom and School Management - Experience and Reflections from the International Training Programme on Child Rights, Classroom and School Management. - 9789198226164 ; 1, s. 217-225
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 14. |
- Rasmusson, Bodil, et al.
(författare)
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Mentors´Reflections
- 2016. - 1
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Ingår i: Realising Child Rights in Education : Experience and Reflections from the International Training Programme on Child Rights, Classroom and School Management - Experience and Reflections from the International Training Programme on Child Rights, Classroom and School Management. - 9789198226164 ; 1, s. 187-217
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 15. |
- Rasmusson, Bodil, et al.
(författare)
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Summing up
- 2015
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Ingår i: Change Projects from the International Training Programme: Child Rights, Classroom and School Management. Final reports. Batch 18.. - 9789198053531 ; Volume 7, s. 197-207
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Bokkapitel (refereegranskat)
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| 16. |
- Wickenberg, Per, et al.
(författare)
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Summing up - Batch 20 : Change Projects from the International Training Programme - Batch 20
- 2015
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Ingår i: Child Rights, Classroom and School Management, Batch 20 : Change Projects from the International Training Programme - Change Projects from the International Training Programme. - 9789198226126 ; , s. 225-232
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Lund University has offered the Sida-financed International Training Programmeon Child Rights, Classroom and School Management since 2003. Theprogramme targets those in a position from which they can initiate processesof change in the education sector in their countries. During the programmeall participating teams initiate a change project in their respective countriesaiming at the realization of the intention of the Child Rights Convention inpolicy as well as in practice. This book contains the final reports from Batch20 with change agents from China, Colombia, DPR of Korea, Indonesia, Malawi,Mozambique, Namibia, Sri Lanka, Uganda, Viet Nam, and Zambia.
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| 17. |
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| 18. |
- Wångdahl Flinck, Agneta, et al.
(författare)
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Summing up - Batch 21: Change Projects from the International Training Programme : Child Rights, Classroom and School Management - Batch 21
- 2016
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Ingår i: Child Rights, Classroom and School Management : Batch 21 - Batch 21. - 9789198226157
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Lund University has offered the Sida-financed International Training Programmeon Child Rights, Classroom and School Management since 2003.The programme targets those in a position from which they can initiate processesof change in the education sector in their countries. During the programmeall participating teams initiate a change project in their respectivecountries aiming at the realization of the intention of the Child Rights Conventionin policy as well as in practice. This book contains the final reportsfrom Batch 21 with change agents from Cambodia, China, Egypt, Ethiopia,Malawi, Namibia, South Africa, Tanzania, Viet Nam, and Zambia.
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| 19. |
- Akbarshahi, Hamid, et al.
(författare)
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Perioperative Nutrition in Elective Gastrointestinal Surgery - Potential for Improvement?
- 2008
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Ingår i: Digestive Surgery. - : S. Karger AG. - 0253-4886 .- 1421-9883. ; 25:3, s. 165-174
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Forskningsöversikt (refereegranskat)abstract
- Nutritional concern is one of the most important issues to be addressed in the perioperative care given to gastrointestinal patients. Not at least, malnutrition may be detrimental and relate to postoperative morbidity. Perioperative nutritional management, integrated with other modern perioperative care policies, allows the establishment of multimodal strategies with an attempt to optimize the patients' course of disease. The present review evaluates available data regarding pre- and postoperative nutrition, nutritional supplements, including immunonutrition, and their clinical role. It is to be concluded that pre- and postoperative prolonged fasting has no routine role in management. Instead, for example, early postoperative feeding administered perorally or enterally may reduce postoperative complications and length of hospital stay. There are also indications that perioperative immunonutrition may reduce postoperative infectious complications and length of hospital stay, though further studies in this field are needed.
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| 20. |
- Andersson, Bodil, et al.
(författare)
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Acute pancreatitis - costs for healthcare and loss of production.
- 2013
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 48:12, s. 1459-1465
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. Severity of acute pancreatitis (AP) can vary from a mild to a fulminant disease with high morbidity and mortality. Cost analysis has, however, hitherto been sparse. The aim of this study was to calculate the cost of acute pancreatitis, both including hospital costs and costs due to loss of production. Material and methods. All adult patients treated at Skane University Hospital, Lund, during 2009-2010, were included. A severity grading was conducted and cost analysis was performed on an individual basis. Results. Two hundred and fifty-two patients with altogether 307 admissions were identified. Mean age was 60 ± 19 years, and 121 patients (48%) were men. Severe AP (SAP) was diagnosed in 38 patients (12%). Thirteen patients (5%) died. Acute biliary pancreatitis was more costly than alcohol induced AP (p < 0.001). Total costs for treating mild AP (MAP) in patients ≤65 years old was lower (p = 0.001) and costs for SAP was higher (p = 0.024), as compared to older patients. The overall hospital cost and cost for loss of production was per person in mean €5,100 ± 2,400 for MAP and €28,200 ± 38,100 for SAP (p < 0.001). The costs for treating AP during the two-year-long study period were in mean €9,762 ± 19,778 per patient. Extrapolated to a national perspective, the annual financial burden for AP in Sweden would be ∼ €38,500,000; corresponding to €4,100,000 per million inhabitants. Conclusions. The costs of treating AP are high, especially in severe cases with a long ICU stay. These results highlight the need to optimize care and continue the identification and focus on SAP, in order to try to limit organ failure and infectious complications.
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| 21. |
- Andersson, Bodil, et al.
(författare)
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Aktuella behandlingsprinciper vid pseudocystor i pankreas. Ultraljud och datortomografi har revolutionerat handläggningen
- 2006
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Ingår i: Läkartidningen. - 0023-7205. ; 103:7, s. 456-459
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Tidskriftsartikel (refereegranskat)abstract
- Pancreatic pseudocysts often complicate the course of both acute and chronic pancreatitis. The management, if the pseudocysts are symptomatic, still remains a substantial clinical problem. Surgical drainage was prior to the introduction of ultrasound and CT more or less the treatment of choice. A vide variety of other treatments have, however, been described that aim to achieve at least as good short and long-term results as surgery, but with reduced trauma, hospital stay and costs. Etiology, anatomy and patients’ preferences are examples of parameters that influence treatment decision making. Different treatment options, including conservative management, different techniques of percutaneus drainage, endoscopic drainage and open and laparoscopic surgery are reviewed.
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| 22. |
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| 23. |
- Andersson, Bodil, et al.
(författare)
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Gastrointestinal complications after cardiac surgery - improved risk stratification using a new scoring model.
- 2010
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 10:3, s. 366-370
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Tidskriftsartikel (refereegranskat)abstract
- Gastrointestinal (GI) complications are serious consequences of cardiac surgery. The aim of this study was to develop, evaluate and validate a new risk score model for GI complications after cardiac surgery. The risk score model, named gastrointestinal complication score (GICS), was developed using prospectively collected data from 5593 patients who underwent 5636 cardiac surgical procedures between 1996 and 2001. The model was validated on 1031 cardiac surgery patients between 2005 and 2006. The scoring system's ability to predict GI complications was estimated by receiver operating characteristic (ROC)-curves and Hosmer-Lemeshow test. Fifty GI complications were identified in 47 patients (0.8%) in the developmental data set and eight (0.8%) in the validation data set. The ROC area in the developmental data set was 0.81 with a good calibration estimated by Hosmer-Lemeshow test (p=0.89). In the validation data set, the area under the curve was 0.83. The estimated probability for the patient to develop a GI complication after cardiac surgery at a GICS >/=15 is >20% and at a GICS
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| 24. |
- Andersson, Bodil, et al.
(författare)
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Gemcitabine Treatment in Pancreatic Cancer – Prognostic Factors and Outcome.
- 2007
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Ingår i: Annals of Gastroenterology. - 1108-7471. ; 20:2, s. 130-137
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pancreatic cancer is generally associated with a poor prognosis and often diagnosed in an advanced stage. The aim of the present study was to evaluate gemcitabine treatment concerning prognostic factors, clinical benefit, tolerance/ toxicity and survival. Methods: Patients with surgically nonresectable, locally advanced or metastatic pancreatic cancer treated with gemcitabine were included. Different parameters, including clinical benefit, toxicity (WHO΄s criteria) and survival were registered. Kaplan-Meier and Cox regression analysis were performed. Results: Forty-two consecutive patients were included. Median age was 62.5 years, 42% were men. Gemcitabine treatment lasted in median for 5 months (0.5-29 months). Median survival from diagnosis was 9.4 months and from start of treatment 8.1 months. Thirteen patients (32%) were alive 12 months after treatment start. The treatment was overall well tolerated concerning toxicity. Seven patients had transient grade 4 reactions. Of 8 parameters selected from the univariate analysis, 3 were identified as independent predictors for longer survival: age >60 years, ≤5 % weight loss at diagnosis and absence of metastases. Conclusions: Gemcitabine treatment in locally advanced and metastatic pancreatic cancer showed to be of potential benefit and well tolerated. Age, weight loss and metastases were independent prognostic factors for survival. The median survival time was longer than previously reported. Keywords: pancreatic cancer; locally advanced; gemcitabine; treatment outcome; prognostic factors
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| 25. |
- Andersson, Bodil, et al.
(författare)
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Pancreatic function, quality of life and costs at long-term follow-up after acute pancreatitis.
- 2010
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Ingår i: World Journal of Gastroenterology. - : Baishideng Publishing Group Inc.. - 1007-9327. ; 16:39, s. 4944-4951
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To evaluate long-term endocrine and exocrine pancreatic function, quality of life and health care costs after mild acute pancreatitis and severe acute pancreatitis (SAP). METHODS: Patients prospectively included in 2001-2005 were followed-up after 42 (36-53) mo. Pancreatic function was evaluated with laboratory tests, the oral glucose tolerance test (OGTT), fecal elastase-1 and a questionnaire. Short Form (SF)-36, was completed. RESULTS: Fourteen patients with a history of SAP and 26 with mild acute pancreatitis were included. Plasma glucose after OGTT was higher after SAP (9.2 mmol/L vs 7.0 mmol/L, P = 0.044). Diabetes mellitus or impaired glucose tolerance in fasting plasma glucose and/or 120 min plasma glucose were more common in SAP patients (11/14 vs 11/25, P = 0.037). Sick leave, time until the patients could take up recreational activities and time until they had recovered were all longer after SAP (P < 0.001). No significant differences in SF-36 were seen between the groups, or when comparing with age and gender matched reference groups. Total hospital costs, including primary care, follow-up and treatment of complications, were higher after SAP (median €16 572 vs €5000, P < 0.001). CONCLUSION: Endocrine pancreatic function was affected, especially after severe disease. SAP requires greater resource use with long recovery, but most patients regained a good quality of life.
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| 26. |
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| 27. |
- Andersson, Bodil, et al.
(författare)
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Prediction of Severe Acute Pancreatitis at Admission to Hospital Using Artificial Neural Networks.
- 2011
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Ingår i: Pancreatology. - : Elsevier BV. - 1424-3903. ; 11:3, s. 328-335
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: Artificial neural networks (ANNs) are non-linear pattern recognition techniques, which can be used as a tool in medical decision-making. The aim of this study was to construct and validate an ANN model for early prediction of the severity of acute pancreatitis (AP). Methods: Patients treated for AP from 2002 to 2005 (n = 139) and from 2007 to 2009 (n = 69) were analyzed to develop and validate the ANN model. Severe AP was defined according to the Atlanta criteria. Results: ANNs selected 6 of 23 potential risk variables as relevant for severity prediction, including duration of pain until arrival at the emergency department, creatinine, hemoglobin, alanine aminotransferase, heart rate, and white blood cell count. The discriminatory power for prediction of progression to a severe course, determined from the area under the receiver-operating characteristic curve, was 0.92 for the ANN model, 0.84 for the logistic regression model (p = 0.030), and 0.63 for the APACHE II score (p < 0.001). The numbers of correctly classified patients for a sensitivity of 50 and 75% were significantly higher for the ANN model than for logistic regression (p = 0.002) and APACHE II (p < 0.001). Conclusion: The ANN model identified 6 risk variables available at the time of admission, including duration of pain, a finding not being presented as a risk factor before. The severity classification developed proved to be superior to APACHE II. and IAP.
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| 28. |
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| 29. |
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| 30. |
- Andersson, Bodil, et al.
(författare)
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Severe Acute Pancreatitis - Outcome following a Primarily Non-Surgical Regime.
- 2006
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Ingår i: Pancreatology. - : Elsevier BV. - 1424-3903. ; 6:6, s. 536-541
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: Severe acute pancreatitis ( SAP) is associated with a high morbidity and mortality. The aim was to evaluate treatment, risk factors and outcome in SAP in a centre with a restrictive attitude to surgery. Methods: All cases of acute pancreatitis admitted 1994 - 2003 were analysed retrospectively. SAP was defined as organ failure and/or hospital stay > 7 days together with one or more of: C-reactive protein > 150 mg/l within 72 h after admission, necrosis on computed tomography and need for treatment in the intensive care unit. Results: 185 (22%) of patients with acute pancreatitis fulfilled the criteria for SAP. 175 patients were included, mean age 61 +/- 17 years. Hospital stay was in median 13 days. Forty-six patients had some surgical intervention, in 14 cases directed at the pancreas (8%). Hospital mortality was 9% (n = 16), in 88% ( n = 14) associated with multiple organ dysfunction and 50% ( n = 8) of the deaths occurred within the first week after admission. Of the parameters registered on admission, age and hypotension (systolic blood pressure < 100 mm Hg) were identified as risk factors for death. Conclusion: The present treatment regime for SAP as defined above resulted in a 9% mortality rate, with age and hypotension at admission as predictive factors for death.
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| 31. |
- Andersson, Bodil, et al.
(författare)
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Surgical stress response after colorectal resection.
- 2013
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Ingår i: International Surgery. - 0020-8868. ; 98:4, s. 292-299
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Tidskriftsartikel (refereegranskat)abstract
- Abstract The human body's response to surgery is correlated with the extent of tissue damage. The aim of the present study was to, over time, map out parameters concerning inflammation, metabolism, nutrition, breathing function, muscle strength, and well-being in elective colorectal surgery. Eighteen patients were prospectively included: colon resection (n = 9) and rectum resection/amputation (n = 9). Postoperative interleukin 10 (IL-10) rose more in the rectum surgery group on day 0 (P = 0.007) and day 3 (P = 0.025). Furthermore, significant differences between groups were detected regarding albumin, prealbumin, and total iron-binding capacity (TIBC). For albumin and TIBC, this difference was seen even on day 7. C-reactive protein, IL-6, IL-8, glucose, cortisol, insulin, pain, fatigue, nausea, grip strength, and forced expiratory volume in 1 second did not show any differences. No correlation was revealed between measured parameters and postoperative complications. Postoperative levels of IL-10, albumin, prealbumin, and TIBC may be used as determinants of surgical stress after colorectal surgery.
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| 32. |
- Andersson, Bodil, et al.
(författare)
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Survey of the management of acute pancreatitis in surgical departments in Sweden.
- 2012
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 47:8-9, s. 1064-1070
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Several international guidelines concerning the treatment of acute pancreatitis has been published during the last decades. However, Scandinavian guidelines are still lacking. The aim of the present study is to identify current treatment strategies for acute pancreatitis in Sweden and to evaluate if there is a need for improvement and the role of guidelines. Material and methods: A questionnaire was e-mailed to the surgical departments at all Swedish hospitals (n = 58) managing patients with acute pancreatitis. Comparisons were made both between university and non-university hospitals, and between hospitals with more versus less than 150,000 persons in the primary catchment population. Results: Fifty-one hospitals responded (88%). In median, 65 (12-200) patients with acute pancreatitis are treated yearly at each hospital. Of 51 hospitals, 18 perform a severity classification, with APACHE II being the most commonly used. A majority are of the opinion that a scoring system is not better than the judgment of a senior consultant. In severe acute pancreatitis, 29/48 routinely administer antibiotics, 29/48 use enteral nutrition, and 25/49 have a standardized follow-up plan. The majority considered administration of intravenous fluids as the most important treatment in severe acute pancreatitis. After mild gallstone-induced acute pancreatitis, the corresponding response was cholecystectomy, especially at larger hospitals (p = 0.002). Of 47, 42 are interested in developing a Scandinavian quality register. Conclusions: The results from this first Swedish national survey provide an insight into current traditions of treatment of acute pancreatitis and points, for example, at the lack of early severity stratification. A majority of hospitals are interested in developing a quality register in acute pancreatitis.
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| 33. |
- Andersson, Bodil, et al.
(författare)
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Survey of the management of pancreatic pseudocysts in Sweden.
- 2009
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 44, s. 1252-1258
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Tidskriftsartikel (refereegranskat)abstract
- Objective . The management of pancreatic pseudocysts varies, based mainly on local traditions, resources and expertise. No prospective, randomized study has been done comparing different approaches to treatment. The aim of the present study was to identify current treatment strategies in Sweden. Material and methods. A questionnaire comprising 12 questions was e-mailed to the surgical departments of all hospitals (n=58) treating patients with pancreatitis. Comparisons were made between university and non-university hospitals and between hospitals with 150 000 or more persons versus less in the primary catchment area. Results. Fifty-one hospitals responded (88%). In median, 4 (0-25) patients were treated yearly due to pancreatic pseudocysts at each hospital. Five hospitals had written guidelines. Multidisciplinary team conferences were held at 36/48 centres. Treatment strategies for acute compared to chronic pancreatitis associated pseudocysts differed significantly depending on the underlying diagnosis in the major hospitals (p=0.005). Overall, 21/49 hospitals refer some of these patients and 15/50 of the departments state that they regularly assist in taking care of patients with pancreatic pseudocysts from other hospitals. The chosen treatment modalities vary widely, above all concerning endoscopic drainage, which is more common for symptomatic non-infected pseudocysts (p=0.005) as well as infected pseudocysts (p=0.004) in university hospitals. Conclusions . The lack of protocols and management strategies for pancreatic pseudocysts is reflected by the heterogeneity in treatment strategies, as seen in the present survey. Therefore patients may be at risk of receiving suboptimal treatment. A tailored therapeutic approach that takes into consideration patient preferences and involves a multidisciplinary team should be considered in all cases.
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| 34. |
- Andersson, Bodil, et al.
(författare)
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Treatment and outcome in pancreatic pseudocysts
- 2006
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 41:6, s. 751-756
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Pancreatic pseudocyst is a common complication of both acute and chronic pancreatitis. The aim of the present study was to evaluate the efficacy and complications of different treatment regimens. Material and methods. All patients >= 15 years of age admitted to Lund University Hospital from 1994 to 2003 with pancreatic pseudocysts were analysed retrospectively. Pseudocysts were defined according to the Atlanta classification. Results. Forty-four patients (29 M (66%), mean age 559/14 years) were included in the study, and all were subjected to treatment on totally 88 occasions. Mean size of pseudocysts at diagnosis was 9.69 +/- 6.8 cm (1.5-40 cm). Recurrence after treatment was 1.0 +/- 1.1 times (range 0-4). No difference was found in recurrence rate or pseudocyst size when comparing conservative versus interventional treatment, but patient weight was higher (p=0.013) and acute pancreatitis was more frequent (p=0.046) in conservatively treated patients. Surgical treatment tended to be associated with a lower recurrence rate as compared with percutaneous treatments. The rate of hospital admissions was in median 3 (0-16) and median length of stay (LOS) was 12 days (0-141 days). Six patients (14%) had complications and 3 died (7%). Pseudocysts >= 8 cm did not differ significantly from smaller pseudocysts regarding the choice of conservative treatment, LOS, recurrence and gastrointestinal obstruction, but there was a trend towards more complications in the group with larger pseudocysts ( 5 versus 1). Conclusions. Patients with pancreatic pseudocysts require frequent hospital admissions and repeated treatments. Larger pseudocysts do not imply more recurrences. The lowest recurrence rate overall was seen after open surgery.
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| 35. |
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| 36. |
- Ansari, Daniel, et al.
(författare)
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Artificial neural networks predict survival from pancreatic cancer after radical surgery.
- 2013
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Ingår i: The American Journal of Surgery. - : Elsevier BV. - 1879-1883 .- 0002-9610. ; 205:1, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Artificial neural networks (ANNs) are nonlinear pattern recognition techniques that can be used as a tool in medical decision making. The objective of this study was to develop an ANN model for predicting survival in patients with pancreatic ductal adenocarcinoma (PDAC).
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| 37. |
- Ansari, Daniel, et al.
(författare)
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CODUSA - Customize Optimal Donor Using Simulated Annealing In Heart Transplantation.
- 2013
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 3:May,30
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Tidskriftsartikel (refereegranskat)abstract
- In heart transplantation, selection of an optimal recipient-donor match has been constrained by the lack of individualized prediction models. Here we developed a customized donor-matching model (CODUSA) for patients requiring heart transplantations, by combining simulated annealing and artificial neural networks. Using this approach, by analyzing 59,698 adult heart transplant patients, we found that donor age matching was the variable most strongly associated with long-term survival. Female hearts were given to 21% of the women and 0% of the men, and recipients with blood group B received identical matched blood group in only 18% of best-case match compared with 73% for the original match. By optimizing the donor profile, the survival could be improved with 33 months. These findings strongly suggest that the CODUSA model can improve the ability to select optimal match and avoid worst-case match in the clinical setting. This is an important step towards personalized medicine.
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| 38. |
- Ansari, Daniel, et al.
(författare)
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Pancreatic cancer : Yesterday, today and tomorrow
- 2016
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Ingår i: Future Oncology. - : Future Medicine Ltd. - 1479-6694 .- 1744-8301. ; 12:16, s. 1929-1946
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Tidskriftsartikel (refereegranskat)abstract
- Pancreatic cancer is one of our most lethal malignancies. Despite substantial improvements in the survival rates for other major cancer forms, pancreatic cancer survival rates have remained relatively unchanged since the 1960s. Pancreatic cancer is usually detected at an advanced stage and most treatment regimens are ineffective, contributing to the poor overall prognosis. Herein, we review the current understanding of pancreatic cancer, focusing on central aspects of disease management from radiology, surgery and pathology to oncology.
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| 39. |
- Ansari, Daniel, et al.
(författare)
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Pancreaticoduodenectomy - the transition from a low- to a high-volume center.
- 2014
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 49:4, s. 481-484
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. Previous studies have identified a significant volume-outcome relationship for hospitals performing pancreaticoduodenectomy (PD). However, scant information exists concerning the effects of increased caseload of PD within the same hospital. Here, we describe the effects of becoming a high-volume provider of PD. Material and methods. The study group comprised 221 patients who underwent PD between 2000 and 2012. Hospital volume was allocated into three groups: low-volume (<10 PDs/year), years 2000-2004, n = 25; medium-volume (10-24 PDs/year), years 2005-2009, n = 86; and high-volume (≥25 PDs/year), years 2010-2012, n = 110. Results. The annual number of PDs increased from 5 in 2000 to 39 in 2012. The median operative duration decreased over the volume categories (p < 0.001). Intraoperative blood loss dropped (p < 0.001). The need for intraoperative blood transfusion was reduced (p < 0.001). Increasing hospital volume was associated with fewer reoperations (p = 0.041) and shorter postoperative length of stay (p = 0.010). There was a tendency toward reduced mortality: 4.0% for the low-volume period, 2.3% for the medium-volume period, and 0% for the high-volume period (p = 0.066). Conclusions. The transition from a low- to a high-volume center resulted in optimized outcomes for PD and 0% operative mortality, favoring the continued centralization of this high-risk operation.
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| 40. |
- Ansari, Daniel, et al.
(författare)
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Protein deep sequencing applied to biobank samples from patients with pancreatic cancer.
- 2015
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Ingår i: Journal of Cancer Research and Clinical Oncology. - : Springer Science and Business Media LLC. - 1432-1335 .- 0171-5216. ; 141:2, s. 369-380
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Tidskriftsartikel (refereegranskat)abstract
- Pancreatic cancer is commonly detected at advanced stages when the tumor is no longer amenable to surgical resection. Therefore, finding biomarkers for early stage disease is urgent. Here, we show that high-definition mass spectrometry (HDMS(E)) can be used to identify serum protein alterations associated with early stage pancreatic cancer.
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| 41. |
- Ansari, Daniel, et al.
(författare)
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Safety of pancreatic resection in the elderly : a retrospective analysis of 556 patients
- 2016
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Ingår i: Annals of Gastroenterology. - : Hellenic Society of Gastroenterology. - 1108-7471 .- 1792-7463. ; 29:2, s. 5-221
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The safety of pancreatic resection for elderly patients is still controversial. We examined the postoperative morbidity and mortality in patients aged 75 years or more undergoing pancreatic resection.METHODS: Patients undergoing pancreatic resection were studied retrospectively and the outcomes were compared between patients aged <75 and ≥75 years.RESULTS: Of the 556 patients enrolled, 78 (14%) were ≥75 years old. Elderly patients had significantly more co-morbidities, especially cardiovascular pathology (P=0.005). Also, elderly patients had significantly lower body mass index prior to surgery (P=0.005). There were no significant differences in terms of surgical procedures and tumor types between age groups. The incidence of postoperative pancreatic fistula grade A was significantly lower in the elderly group (P=0.022), but no significant differences were noted in the overall morbidity or the incidence of postpancreatectomy hemorrhage, delayed gastric emptying, bile leakage, cardiac complications, pulmonary complications or septic complications. The 30-day mortality rate was similar between groups (0.8% vs. 1.3%; P=0.532).CONCLUSION: Pancreatic resection is a safe option for selected elderly patients. Our study confirms that age alone should not preclude potentially curative surgical therapy.
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| 42. |
- Ansari, Daniel, et al.
(författare)
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Single-institution experience with solid pseudopapillary neoplasm of the pancreas.
- 2011
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 46:12, s. 1492-1497
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare clinical entity. The objective of this study was to review a single institution's experience with this uncommon tumor, as well as review the literature. Material and Methods. Consecutive patients, who underwent surgery for a pathologically confirmed SPN between 1991 and 2010, were retrospectively reviewed. A PubMed search (January 1980-June 2011) was conducted to identify risk factors for death among SPN patients. Results. The institutional review identified 16 patients with SPN. Thirteen patients were female and three patients were male (median age 34 years). All patients underwent radical resection. Two patients had metastatic disease at the time of operation as evident by the presence of lymph node metastasis and gallbladder metastasis. One developed liver metastasis 4 months postoperatively and subsequently died. The other patient received adjuvant chemotherapy (gemcitabine and capecitabine), and 23 months after the initial operation, no tumor recurrence was detected and the patient is still alive. All other patients remain disease-free. Analysis of 29 fatalities reported in the English literature (including the present case) revealed several atypical features including male gender, old age, tumor size >5 cm, diffuse growth pattern, cellular or nuclear atypia, high mitotic rate, extensive necrosis, extrapancreatic invasion, metastasis and incomplete resection. Conclusions. SPN is not always indolent. Male patients and those with old age, atypical histopathology (large tumors, diffuse growth, cellular/nuclear atypia, mitotic activity, necrosis, invasion/metastasis) and incomplete resection may have a higher risk of recurrence and death, deserving particular attention.
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| 43. |
- Ansari, Daniel, et al.
(författare)
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Surveillance after surgery for pancreatic cancer : a global scoping review of guidelines and a nordic survey of contemporary practice
- 2024
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Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor & Francis. - 0036-5521 .- 1502-7708.
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Forskningsöversikt (refereegranskat)abstract
- Objectives: Most patients with pancreatic cancer who have undergone surgical resection eventually develop disease recurrence. This study aimed to investigate whether there is evidence to support routine surveillance after pancreatic cancer surgery, with a secondary aim of analyzing the implementation of surveillance strategies in the Nordic countries.Materials and Methods: A scoping review was conducted to identify clinical practice guidelines globally and research studies relating to surveillance after pancreatic cancer resection. This was followed by a survey among 20 pancreatic units from four Nordic countries to assess their current practice of follow-up for operated patients.Results: Altogether 16 clinical practice guidelines and 17 research studies were included. The guidelines provided inconsistent recommendations regarding postoperative surveillance of pancreatic cancer. The clinical research data were mainly based on retrospective cohort studies with low level of evidence and lead-time bias was not addressed. Active surveillance was recommended in Sweden and Denmark, but not in Norway beyond the post-operative/adjuvant period. Finland had no national recommendations for surveillance. The Nordic survey revealed a wide variation in reported practice among the different units. About 75% (15 of 20 units) performed routine postoperative surveillance. Routine CA 19-9 testing was used by 80% and routine CT by 67% as part of surveillance. About 73% of centers continued follow-up until 5 years postoperatively.Conclusion: Evidence for routine long-term (i.e. 5 years) surveillance after pancreatic cancer surgery remains limited. Most pancreatic units in the Nordic countries conduct regular follow-up, but protocols vary.
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| 44. |
- Aronsson, Linus, et al.
(författare)
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High-density and targeted glycoproteomic profiling of serum proteins in pancreatic cancer and intraductal papillary mucinous neoplasm
- 2018
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 53:12, s. 1597-1603
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Glycoproteomics is an emerging subfield of proteomics. Tumor-specific variations in protein glycosylation might be potential targets for the development of new cancer diagnostics. Here, we performed high-throughput screening and targeted verification of glycome alterations in serum samples from patients with pancreatic cancer and the precancerous lesion intraductal papillary mucinous neoplasm (IPMN). Material and methods: The glycosylation profile of 1000 proteins was mapped in a discovery cohort comprising serum samples from 16 individuals, including 8 patients with pancreatic cancer and 8 healthy controls. The top 10 glycoprotein biomarker candidates with the highest signal intensity difference in glycosylation levels were evaluated in a cohort consisting of 109 serum samples, including 49 patients with resectable pancreatic cancer, 13 patients with resectable noninvasive IPMN and 47 healthy controls, using a targeted assay. Results: Multivariable analysis defined sets of panels comprising CA19-9 and distinctively glycosylated proteins for discrimination between pancreatic cancer, IPMN and healthy controls. A panel including CA 19-9, IL.17E, B7.1 and DR6 gave an AUC of 0.988 at 100% sensitivity at 90% specificity for the discrimination of stage 1 pancreatic cancer and healthy controls. B7.1 was found to be a valuable biomarker for differentiating between IPMN and healthy controls, with better performance alone than CA 19-9. Conclusions: Measurement of protein glycosylation profiles in serum may aid in the early detection of pancreatic cancer and precursor lesions.
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| 45. |
- Aronsson, Linus, et al.
(författare)
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Intraductal papillary mucinous neoplasms of the pancreas – a cost-effectiveness analysis of management strategies for the branch-duct subtype
- 2018
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Ingår i: HPB. - : Elsevier BV. - 1365-182X. ; 20:12, s. 1206-1214
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Tidskriftsartikel (refereegranskat)abstract
- Background: Branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) presents a clinical conundrum. Rigorous long-term surveillance or surgical resection is recommended. The economic consequences of the management have not been fully investigated. Methods: A Markov decision model compared 4 strategies for low-risk BD-IPMN: I = upfront total pancreatectomy, II = upfront partial pancreatectomy, III = initial surveillance, IV = watchful waiting. Surveillance was based on the Swedish Guidelines for Pancreatic Cancer. Probabilities and costs were obtained from the participating unit and from the scientific literature. The incremental cost-effectiveness ratios (ICERs) were calculated and sensitivity analyses were performed by varying relevant parameters. Survival was reported in quality-adjusted life-years (QALYs). Results: Strategy III was the most cost-effective strategy with an ICER of €31 682 compared to strategy IV. Strategy I was the most expensive but yielded the best QALY (9.32). Total number of years, annual risk of pancreatic cancer and annual risk of a low-risk BD-IPMN turning into a high-risk lesion had the greatest impact in the model. Conclusions: Initial surveillance seems to be the most cost-effective strategy in the management of low-risk asymptomatic BD-IPMN. However, the possibility of personalized approaches remains to be investigated.
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| 46. |
- Bartosch-Härlid, Anna, et al.
(författare)
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Artificial neural networks in pancreatic disease.
- 2008
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 95:7, s. 817-826
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: An artificial neural network (ANNs) is a non-linear pattern recognition technique that is rapidly gaining in popularity in medical decision-making. This study investigated the use of ANNs for diagnostic and prognostic purposes in pancreatic disease, especially acute pancreatitis and pancreatic cancer. METHODS: PubMed was searched for articles on the use of ANNs in pancreatic diseases using the MeSH terms 'neural networks (computer)', 'pancreatic neoplasms', 'pancreatitis' and 'pancreatic diseases'. A systematic review of the articles was performed. RESULTS: Eleven articles were identified, published between 1993 and 2007. The situations that lend themselves best to analysis by ANNs are complex multifactorial relationships, medical decisions when a second opinion is needed and when automated interpretation is required, for example in a situation of an inadequate number of experts. CONCLUSION: Conventional linear models have limitations in terms of diagnosis and prediction of outcome in acute pancreatitis and pancreatic cancer. Management of these disorders can be improved by applying ANNs to existing clinical parameters and newly established gene expression profiles.
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| 47. |
- Bartosch-Härlid, Anna, et al.
(författare)
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Artificiella neurala nätverk underlättar svåra medicinska beslut. Exempel från pankreatologin.
- 2009
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Ingår i: Läkartidningen. - 0023-7205. ; 106:39, s. 2446-2448
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Tidskriftsartikel (refereegranskat)abstract
- Artificial neural networks (ANNs) is a nonlinear pattern recognition technique inspired by the function of the human brain. ANNs have been used successfully in analysis of complex medical relationships, for example prognostic predictions of various forms of cancer. Acute pancreatitis and pancreatic cancer are commonly recognized to be extremely difficult conditions in making diagnostic and prognostic predictions with traditional methods. The two pancreatic disorders thus represent suitable candidates for analysis by ANNs. We hereby present a systematic review of the applications of ANNs in the treatment of acute pancreatitis and pancreatic cancer.
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| 48. |
- Bauden, Monika, et al.
(författare)
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Circulating nucleosomes as epigenetic biomarkers in pancreatic cancer.
- 2015
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Ingår i: Clinical Epigenetics. - : Springer Science and Business Media LLC. - 1868-7075 .- 1868-7083. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- To improve the prognosis of patients with pancreatic cancer, new biomarkers are required for earlier, pre-symptomatic diagnosis. Epigenetic mutations take place at the earliest stages of tumorigenesis and therefore offer new approaches for detecting and diagnosing disease. Nucleosomes are the repeating subunits of DNA and histone proteins that constitute human chromatin. Because of their release into the circulation, intact nucleosome levels in serum or plasma can serve as diagnostic disease biomarkers, and elevated levels have been reported in various cancers. However, quantifying nucleosomes in the circulation for cancer detection has been challenging due to nonspecific elevation in sera of patients with benign diseases. Here, we report for the first time differential, disease-associated epigenetic profiles of intact cell-free nucleosomes (cfnucleosomes) containing specific DNA and histone modifications as well as histone variants circulating in the blood. The study comprised serum samples from 59 individuals, including 25 patients with resectable pancreatic cancer, 10 patients with benign pancreatic disease, and 24 healthy individuals using Nucleosomics(®), a novel ELISA method.
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| 49. |
- Bauden, Monika, et al.
(författare)
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Histone profiling reveals the H1.3 histone variant as a prognostic biomarker for pancreatic ductal adenocarcinoma
- 2017
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Ingår i: BMC Cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epigenetic alterations have been recognized as important contributors to the pathogenesis of PDAC. However, the role of histone variants in pancreatic tumor progression is still not completely understood. The aim of this study was to explore the expression and prognostic significance of histone protein variants in PDAC patients. Methods: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was employed for qualitative analysis of histone variants and histone related post-translational modifications (PTMs) in PDAC and normal pancreatic tissues. Survival analysis was conducted using the Kaplan-Meier method and Cox proportional hazards regression. Results: Histone variant H1.3 was found to be differentially expressed (p = 0.005) and was selected as a PDAC specific histone variant candidate. The prognostic role of H1.3 was evaluated in an external cohort of patients with resected PDAC using immunohistochemistry. Intratumor expression of H1.3 was found to be an important risk factor for overall survival in PDAC, with an adjusted HR value of 2.6 (95% CI 1.1-6.1), p = 0.029. Conclusion: We suggest that the intratumor histone H1.3 expression as reported herein, may serve as a new epigenetic biomarker for PDAC.
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| 50. |
- Bengtsson, Axel, et al.
(författare)
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Organoid technology for personalized pancreatic cancer therapy
- 2021
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Ingår i: Cellular Oncology. - : Springer Science and Business Media LLC. - 2211-3428 .- 2211-3436. ; 44:2, s. 251-260
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Forskningsöversikt (refereegranskat)abstract
- Background: Pancreatic ductal adenocarcinoma has the lowest survival rate among all major cancers and is the third leading cause of cancer-related mortality. The stagnant survival statistics and dismal response rates to current therapeutics highlight the need for more efficient preclinical models. Patient-derived organoids (PDOs) offer new possibilities as powerful preclinical models able to account for interpatient variability. Organoid development can be divided into four different key phases: establishment, propagation, drug screening and response prediction. Establishment entails tailored tissue extraction and growth protocols, propagation requires consistent multiplication and passaging, while drug screening and response prediction will benefit from shorter and more precise assays, and clear decision-making tools. Conclusions: This review attempts to outline the most important challenges that remain in exploiting organoid platforms for drug discovery and clinical applications. Some of these challenges may be overcome by novel methods that are under investigation, such as 3D bioprinting systems, microfluidic systems, optical metabolic imaging and liquid handling robotics. We also propose an optimized organoid workflow inspired by all technical solutions we have presented.
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